PNEUMONIA ASSOCIATED TO MECHANICAL VENTIL ATION AND PROPHYLAXIS OF STRESS GASTRIC-ULCER - RANDOMIZED CLINICAL-TRIAL OF ANTACIDS AND RANITIDINE VERSUS SUCRALFATE

BACKGROUND: To study two groups of patients intubated with different p rophylaxis of stress gastric ulcer in a prospective randomized trial. The differential effect on gastric pH, gastric colonization and the in cidence of pneumonia associated to mechanical ventilation (PMV) were a nalyzed. METHODS: A prospective randomized study was carried out in tw o groups of patients: 1) prophylaxis with antiacids and H2 blockers (A A+H2) and 2) prophylaxis with sucralfate. Intubated patients without i nitial respiratory infection were included in the protocol. Periodical ly gastric aspirations were collected measuring gastric pH and perform ing semiquantitative cultures. When pneumonia was suspected bronchial brushing was carried out with telescoped catheter (BBTC) and quantitat ive culture. RESULTS: Fifty-one patients were studied (n = 51), distri buted into 25 in the AA+H2 group and 26 in the sucralfate group. In th e first group mean pH was higher (5.3 +/- 1.7) than in the sucralfate group (3.2 +/- 2.1) (p = 0.006). Nosocomial pneumonia (NP) was suspect ed on 25 occasions: 20 patients were positive for NP, 11 in the AA+H2 group and nine in the sucralfate group with no significant differences being observed. S. aureus, S. pneumoniae and H. influenzae (n = 14) w ere the etiology of predominant PMV. The global mortality of the group was of 22%. CONCLUSIONS: The prophylaxis of stress ulcers in intubate d patients treated with antiacids and ranitidine provoked higher gastr ic pH and an increase in gastric colonization in comparation to that o bserved with sucralfate. No significant differences were observed in t he frecuency of pneumonia by PMV diagnosed by BBTC.